Individual
MS. KIMBERLY RAE GUSTAFSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MN, NNP, ARNP
Contact information
Practice address
315 MLK JR. WAY, MS ZO-NTL, TACOMA, WA 98405
(253) 403-1019
Mailing address
3800 BRIDGEPORT WAY W, PMB #532, UNIVERSITY PLACE, WA 98466-4495
(253) 403-1019
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
AP30004020
WA
Other
Enumeration date
05/18/2006
Last updated
07/08/2007
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